JSOM Fall Podcast

This article, Testosterone for the Management of Traumatic Hemorrhage, a Systemic Review, looked at whether exogenous testosterone could improve outcomes in patients with acute traumatic hemorrhage.

The rationale comes from testosterone's known effects on red blood cell production, platelet activity, vasoconstriction, and its association with clotting.

To do this, the authors performed a systematic review using PRISMA and registered it in the PROSPERO.

In simple terms, PRISMA is like a checklist that helps make sure a systematic review is done and reported in a clear and organized way.

PROSPERO is like writing down your research plan before you start, so the question and methods are established before the researchers see the results.

They started by searching several databases for relevant studies.

To qualify, the studies had to involve patients 16 or older with traumatic hemorrhage, evaluate exogenous testosterone or another potent androgen given before or within 24 hours of injury, and report acute clinical outcomes such as coagulation, transfusion requirements, thromboembolism, length of stay, and mortality.

The review was also limited to English language studies only, so non-English publications were excluded.

The results were pretty straightforward.

They identified 215 studies, but after screening and full text review, none met the final inclusion criteria.

So there are currently no eligible human studies showing whether exogenous testosterone during acute traumatic hemorrhage is beneficial or harmful.

However, the authors did review related animal and laboratory studies.

Those studies did not show a clear acute hemostatic benefit from testosterone, and some actually suggested it could increase inflammation after hemorrhagic shock.

Some experiments they found in data also suggested estrogen may be more protective than testosterone.

But the bottom line is that there is currently not enough human evidence to support or refute testosterone as a treatment for acute traumatic hemorrhage and more research is needed.

That's super interesting, Paul.

I had never thought of using testosterone in acute traumatic cases.

That one other thing to the author's point is that studying this pre-injury androgen exposure is especially important.

I think rather than asking whether we should give testosterone to a bleeding casualty, maybe the first question should be what happens when a casualty is already taking testosterone.

It really becomes more of a hypothesis-generated paper than a practice-changing one.

Yeah, I think that that's a good question of what How does it affect guys when they receive traumatic injuries that have already you know, maybe been on some form of testosterone, whether it be for TRT or, you know, if people are using it at a potentially anabolic dosage, how does that affect their clotting cascade and their potential to recover from traumatic injuries? That'd be an interesting conversation.

I do, especially when you mentioned pre-dosing, when we look at this kind of prolonged field care, particularly when trying to optimize outcomes in hemorrhage and shock, especially as we look towards this large-scale combat with resource-constrained environments, for example, Ukraine, with this traditional golden hour going away and how it's going to affect casualty outcomes.

One thing I am kind of curious about is the exclusion of non-English studies and whether they're potentially missing any useful observations from other countries or conflict settings.

The authors do acknowledge that restricting the review to English language publications could have caused them to miss some relevant findings.

Yeah, I